Meeting documents

Purpose:

As well as the NHS long term plan, the new GP contract has been published which is a 5 year framework to support the long term plan. The GP contract highlights the development of Primary Care Networks (PCN).  PCNs enable the provision of proactive, accessible, co-ordinated and more integrated primary and community care.

Representatives from Buckinghamshire GPs will present the local plans for PCNs.

Attendees:

Dr P Macdonald

Dr M Thornton

Papers:

Presentation attached

Intended outcome:

For Committee Members to gain a greater understanding of how PCNs will work across Buckinghamshire and how this new approach will deliver better outcomes for patients.

The Chairman welcomed Dr P Macdonald, Chair of FedBucks and Dr M Thornton, Clinical Director of FedBucks.

The following main points were made during the presentation and the discussion.

·         The GP Federation provides an opportunity for practices to work together to build community models of care and to work at scale.

·         The five year plan would help practices with their planning and provide stability.

·         Part of the new GP contract involved enhanced services and developing Primary Care Networks (PCNs) which were a vehicle for bolting on an integrated team and a place based care service.

·         PCNs would provide additional resilience and support for GPs and provided an opportunity for practices to work together and develop a new community model of care.  This would result in better outcomes for the patients.

·         The Networks would be made-up of around 30-50,000 population size although some networks can be larger than this and there had to be a connection geographically. 

·         One of the key advantages of the new PCNs was around additional support for the workforce. The Government had a target of recruiting 5,000 new GPs which had been very difficult to achieve.

·         There were five different areas:

o   Pharmacists;

o   Social prescribers;

o   Physician Associates;

o   Physiotherapists;

o   Community paramedics.

·         The new workforce would be rolled out across the PCN over the next 3 years.

·         The new contract included indemnity packages for GPs.

·         There were also new service specifications within the contract which focussed on the following areas:

o   Medication reviews, bringing pharmacists into the network means that more advanced medication reviews can take place which would be of particular importance in care homes;

o   Care Homes – more general practice in this setting;

o   Anticipatory care – preventing people from admittance to Hospital;

o   More personalised care for patients with specific needs;

o   Early cancer diagnosis – earlier access to diagnostic services to detect stage 1 and 2;

o   Tackling inequalities – additional funds to tackle this.

·         Would like strong patient engagement in this and there was a need to involve the voluntary sector.

·         A priority would be to look at the local population and redesign the services to meet the local needs.

·         Quality and service improvement managers would be appointed to look at what currently works and build on this.

·         In general, a positive move for GPs and better care for patients would be provided.  Opportunity to develop as time goes on as it was a 2-5 year project.

·         In Somerset, a model had been developed which resulted in a reduction of 30% in Hospital admissions.  This was due to finding problems across the whole population, better outcomes for patients, identifying problems earlier and intervening earlier to find solutions.

·         PCNs would use "Community connectors" – people in the community who are the eyes and ears and connect people with the system.

·         Single digital record will help to see the patient story.

·         In response to a question about the role and scope of the Physician Associates, Dr Thornton explained that they would play a similar role to nurse practitioners and would deal with minor illness or be specialists in a specific illness.

·         Working in partnership would help to identify people who had specific needs, for example, those with dementia.

·         In response to a question about the £4.5 billion investment, Dr Macdonald explained that each practice would be funded £1.50 per patient to the network and £1.75 per patient for administration to help set-up the networks.

·         In the first year, there would be no cost to the network for the social prescribers as these would be funded by NHS England.  The Physician Associates and other posts will be reimbursed 30% by NHS England and 70% by the network.

·         Dr Thornton provided an example of a PCN with a population size of 40,000, by the end of year 5, the PCN would receive £700,000 of funds towards the new workforce.  There would be five new clinical pharmacists in this PCN, partly funded by the Government and the PCN.

·         No GP practice would be left out of a PCN.  The Clinical Commissioning Groups and NHS England would negotiate with practices if there were any issues.

·         The timescales were very tight but as the PCNs develop, the patient voice would be key as part of future development. The Patient Participation Groups would also have a voice in shaping the new model of care.

·         A Member commented that the GP landscape was changing which meant that sometimes patient trends were not being picked up due to not seeing the same GP.  Dr Macdonald responded by saying that recruitment and retention was a major challenge within General Practice.  This had been recognised by NHS England which was part of the reasoning behind the new roles within the PCNs. Hopefully more graduates would be attracted to General Practice.

·         A Member mentioned that the gap in life expectancy was 12 years between the least deprived areas and the most deprived areas in Buckinghamshire.

·         A Member commented that the report states that there would be more recognition for carers.  Dr Macdonald explained that it was early days and this was a 2-5 year plan.  Need to involve stakeholders in the planning and this would include carers and organisations supporting carers.

·         The PCNs would go live on 1 July so new staff would start to be recruited after this date.

·         In response to a question about the 7 localities and 7 multi-disciplinary teams and how they would be integrated, Dr Macdonald explained that the PCNs were vehicles for streamlining services and delivering a more integrated service to allow greater access to services for patients.

·         Funding for the networks would be separate from the funding for GP practices to allow resources to be tailored to meet local needs.

The Chairman thanked the presenters for attending.